Patients Often Use Emergency Rooms for Non-Urgent Care

October 24, 2003

Visits to hospital emergency departments (EDs) have increased greatly in recent years, contributing to crowded conditions and ambulance diversions. Contrary to the popular belief that uninsured people are the major cause of increased emergency department use, insured Americans accounted for most of the 16 percent increase in visits between 1996-97 and 2000-01, according to a study by the Center for Studying Health System Change (HSC).

Less than half of ER visits (47 percent) are truly emergencies requiring care within an hour or less. Because the cost of treating patients is higher in the ED than in outpatient clinics and medical practices, increased use of the ED for many non-urgent health problems will contribute to higher health insurance costs.

According to HSC, most striking is the increase in ER visits by patients with private health insurance -who increased by about one quarter despite a population increase of less than five percent:

ER visits by Medicare beneficiaries rose 2.5 times their respective population increase.

The uninsured population did not climb during this period although the number of ER visits rose by about 10 percent.

The bright spot in the study was that visits by Medicaid enrollees did not increase despite an increase of 10 percent in the population.

Attempts by private plans during the 1990s to restrict ED use for non-urgent problems resulted in a consumer backlash. The subsequent retreat from tight restrictions may have contributed to the large increase in ED use by privately insured persons.

Higher copayments for nonurgent ED use may be one of the few tools that private health plans have left to control use. Charging uninsured patients and being more aggressive in collecting payments may also be effective in reducing non-urgent use of the ED by uninsured patients.